1Moving Out of Back Problems

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=----Self HealingMoving Out OfBack h bby Meir Schneider and CarolGallzlp

ark Donegan, of RedwoodValley, California, says,"I'm fid-gety because of pain; my body's

telling me to move, so I do it everywhere-on the bus, sitting around with friends,wherever I am." Donegan, 36, is recoveringfrom a very painful back problem tharnearly crippled him, a herniated interverte-b d disk in the lumbar spine. He weanedhimself off heavy medications ofired byphysicians and chose instead to heal him-self through natural movement, the keyelement in self-healing.

Moving in a natural way frees you. It iswell-known in movement science thar theskilled ~erformer as more degrees of free-dom (movement choices) than the novice.When you look at a film of Fred Astaireand Ginger Rogers dancing, you feel theirlooseness, ease and pleasure in movement.It says a lot about our culture that they hadto work hard to make it second nature tomove easily.As they dance, you see thattheir muscles work only as hard as appro-priate and don't substitute for the work ofother muscles (the principle of isolation).Without tensing up the abdominals, theymove loosely from their center (the navelarea). It's much less efforthl, energy-costlyand wearing than the "normal" movementpatterns most of us exhibir, which eventu-ally create chronic health problems.

Athieres and dancers don't necessarilymove naturally; when they use the body asa tool, they block out a sense of its prob-lems and needs. Natural movement comesout of kinesthetic awareness, a deep, subtlesense of movement-of breath, energy,blood and other fluids throughout thebody, of joints finding their full range in allplanes, of muscles becoming supple, strongand balanced. You become aware of thebody's specific need for movement at anygiven time. Natural movement heals-itincreases circulation, reduces inflamma-tion, creates strength, endurance and a-sense of well-being, and nurtures every part

of the body, including the joints. Helpingthe client restore n a t u d movement isessential in working with joint and spineproblems.

Unfortunately, most people move in anunbalanced, constricted way. This kind ofmovement-patterns of overuse, underuseand misuse-is damaging to the joints,including those of the spine. Doing moreof it in the name of "exercise" will onlymake you worse.

We suggest reviewing the article,"Movement is Life," (Issue#60, March1April 1996); those exercises and principlesare helpful with back problems.A back problem years in themaking

When Donegan was 29, his job requiredhim to climb up and jump down to fetchitems from grocery stockrooms many timesa day. "We were expected to move fast," hesaid. He woke up one morning feeling thathis left leg didnt want to move. A chiro-practor diagnosed herniated disk (alsoknown as disk prolapse or slipped disk), acomplication of degenerative disk disease.Like cartilage, intervertebral disks in thespinal column are believed by physicians todegenerate inevitably, beginning at earlyadulthood. As a complication, the diskmay herniate or rupture. A strong ligamentkeeps it from bplging directly backward, soit moves posterolaterally, where it maycompress or stretch a spinal nerve root.The result is radiating pain, muscle weak- .ness and sensory losses, always along thedistribution of the spinal nerve. This isactually one form of sciatica, which canalso begin with compression further downthe nerve. Most prevalent in young men,herniated disk is rare afrer middle age,because the disk has lost a lot of its mass.

Four months of chiropractic treatmentonly aggravated the problem. Donegantried physical therapy, and it worsenedagain, until muscle spasm and pain pre-vented movement in the leg altogether.

Two surgeries brought only temporaryrespite. In the first operation, part of thedisk and of the bony arch around thespinal cord were trimmed away; in the sec-ond, more of the disk was removed andtwo vertebrae were fused together. Afterthe second surgery, new symptoms cameon-numbness in the left leg, high bloodpressure, irregular heart rate, bowel andbladder problems. The right leg had beenthe anchor for crutchwalking; now he lostsensation and movement in it, too."I was looking at a wheelchair next,"Donegan said. "I was depressed-mywhole world was falling apart. The paingave me nausea and vomiting. Let me tellyou about extreme pain. You can take it fora day and ir's okay. Two days, and you startgetting tired of it, bur on the third day, youdon't have anything left. You're nor youanymore."

Another surgeon told Donegan he couldremove the rest of the damaged disk and-stabilize the region with bone transplantsand internal braces and screws. Therewould be a new source of pain, however,from the braces. The surgery restored hisability to walk but left his back swollen andpainful, and "Ihad nothing left, no will,"Donegan said. At a pain clinic inMendocino, California, Donegan beganworking with massage therapist AudreyFerrell, who practices neuromuscular ther-apy. Ferrell gave him massage and move-ment exercises. Gradually his pain abatedenough that he could resume his favoriteactivity, bicycling- ''I gave the doctor backall of his prescription pain medications; theonly thing I kept was over-the-counteribuprofen." A year later, Ferrell broughthim to Meir Schneider. "Meir glanced atme and told me where my pain was,"Donegan recalls.

While Schneider'sevaluationseemed fastand effortless to Donegan, he used, asalways, the method he teaches students:start with observations of the client walk-


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ing bo th forward and backward, sitting,climbing stairs and doing other functionaltasks. Overa ll, Schneider says he assessesstiffness vs. fluidity in the movement ofeach body segment; rhese are issues wi thmany health problems. Th e key is isola-tion, or independent movement of eachbody segment. "In the extreme case," he 'says, "paralyzed people have a concept o f'legs' tha t needs to be diEerentiated; they'veforgotten tha t the ir legs can move sepa-U rately from each 0 t h Witho ut isolation,3 you have s&ess.>nn "Often, with back problems like Mark's,"Schneidersays, "the way onehas used theE legs rhroughout life creates lower backdamage. Mark's knees never I l l y extend ashe&. H e pushes himself &om theupper back-&ere's too much forwardiean. At the time, he held his head forwardand his shoulders forward and up; this hasimproved. Bicycling fit right into thisdynam ic posture and aggravated it. Mark's

back is poorly organized, with extteme stiff-ness in the thoracic paraspinals and weak-ness, comparadvely, above and below."HisEace and neck hold a lot o f unre-solved e m o ti o n ja w locked, sternodeid-mastoids and anterior neck generally verytight. His ab dominals are also extremelystiff. His stiff areas-anterior neck, ante riorand posterior chest, and ab dom inal+ -dominate his every movement."Mark is strong, fast an d capable-he'sspent years weightlifting and mestling.Unfbrmnately, bein g beefitd up makes it

harder to clear up movement imbalances;you've invested that much more in badmovement patterns.' 'W~thmovement imbdances, musclesate working in packs-big, insensateblocks, where a group of proximal musclestense up to 'help' inappropriately with thework of a distal muscle. You may see apsoaslpectoralsl stemocleidomastoid/sca-lene block like Mark's. Or your client mayhave a giuteal/hamstringlparaspinal/shoul-der block, coupled with weak neck an db,patrern ofien seen in nearsighted-ness. O r you may see an arched lower back,protru ding chest, with overworked uppertrapezius, lower pectorals, rhomboids andparaspinals; this pattern goes with hrs ight-edness. Massage therapists need to carearefullyidenti@ the client's whole block."sho;tly after the dynamic posture evalu-ation, Schneider's massage begins; i t is amajor evaluative tool. "I observe the client'sbreathing habits, generally and specifically.

Simng, onegan pe@m zs navel rotations in the transverse ph ne .These are done both clockwise and cozcnterclockwise.

Peoph breathe into an area that is beingmassaged; areaswhere this is delayed areproblem atic. Mark's breathing was veryshallow, in the chest mostly, with effortfulexhalations. He didn't breathe at ail into thebadL And there were, as I expected, rthriticand fused joints in the lumbar area."Isaw that Mark's problem s started along time before he ever had symptoms.Too many people look at the end result-the hern iated disk in Mark's case-of a iife-long movement p roblem as if this symp-tom were the real problem you have tosolve, but it's not. Mark learned early ontha t he has to fight for survival; it's in everymove he makes (Mark is a survivor ofchildhood physical abuse). The problem

may have started with psychological armor-ing. It wasn't the job-related jumping th athu rt his back: it was the stiffness in hisjumping. Bs his pain developed, Mark mayhave physiologically splin ted against i t(tightened up muscles to shore up an areathe body perceives as weak or threatened),i n t e n s i ~ n kis muscle spasms or addingmore. To heal himself, M ark was going tohave to change hiis movement patterns, an dthis was going to create changes at everylevel of his being."Physical therapy sees essentially twokinds of musde imbalances involved inlower back pain-too much lumbar curve(hyperlordotic) or too little (flat lowerback). Theymay apply the classic test-have the patient stand against a wall andsee how m any hands' widths he o r she canfit into the lumbar curv e- on e is normal,zero o r two are problematic. The patient isrhen asked to do a standing forward bendand backbend and describe how each

In each of the photosshown with (his arlicle,Mark Donegan demon-strates the exercise reg-imen designed by theCenter for Self HealingDonegan is recoveringfrom a herniated nter-vertebral disk in thelumbar spine. He choseto heal himself throughnatural movement,rather than rely on painmedications. I n eachphoto, his limited rangeof movement is evident.

changes the pain. If it lessens or radiatesless, this is the therapeu tic direction formovement-pain in the flat lower back isrelieved by backbending; in the hyperior-dotic lower back, by forward bending. Twoleaders in the rehabilitation of backs havelent their names to these diagnoses/regi-men= the Williams protocol is predomi-nantly a spinal flexion program for hyper-Iordotic backs; the MacKenzie, spinalextension for flat low backs.Schneider says this is useful, as fi r as itgoes. Carol Gallup th inks the wlliamslMacKenzie dis tinction is ofien underem-phasized in th e holistic health community."A ffewyears ago, during physical therapyschool, I worked briefly with a youngwoman with serious lower back pain, radi-ating down the Iegs, with movement andsensory losses in the legs. Kendra's backpain began after she aiiowed a friend whohappened to be a holistic health practi-tioner to work with her for a fewmonthsto 'correct' her posture; before tha t she hadhad no problem. Th is practitioner believed,on the basis of his training, t hat the normallumbar curve was unhealthy, and that everylower back should be flat. He did indeedflatten out her lum bar curve-and createda serious back problem for his di en t."I see ttyo morals in this story-first, theold saying, 'if it ain't broke, don't fix it.'Second, listen to the bioengineers and bio-mechanics. They're telling us tha t theincredible ability of the back to withstandthe stresses we subject it to every day iscaused in part by its shape-essentially, it's

a spring, with the resiliency of a spring,and it needs the normal am oun t of kypho-sis in the upper back and the normal


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amount of loriiosis in the lower back. So In the prone position,when I met Ken& she had a MacKenzie' Donegan pmsivcLy &end the upper backback I gave Kendra some standing and by extending hhs elbows, then he activelyother [types ofl badcbends, and her pain e x t d oth the upper and lower back.immediately started to lessen and centralize(radiate Iess), a sure sign that backbendingwas an important direction to take withher theraw.

"I myself happen to tend in the oppositedirection, hyperlordotic-a Williams'back. I've found that I do best if, for everysix or eight spinal flexion exercises, I do twoor three spinal extensions. Bear in mind work, and ignoring others. A good pro-also that serious lower back pain can occur gram for clients with spine, joint andwhen the lower back curve is normal-the many other problems involves seriousclient may still have muscle tightness, mus- reprogramming, Most of us have immo-cle spasm, very limited mobility." bile toes, for example, &om walking in

W ~ t hhe Williams protocol, physical shoes on cement sidewalks, so that our toes between brisk shaking of the muscle andtherapists tend to automatically add exer- axid feerdidn't develop a pattern of pleasur- tapotement), tapotement, deep tissue mas-uses to strengthen the abdominals. We able sensorimotor interaction with the sage,breathing exerciseeand the clientknow someone who had such severe back ground; we can create such a pattern by walks out much looser, feeling great, think-pain that he was admitted to the hospital; walking and running on a beach or grassy ing you're wonderfd. But the dynamica physical therapist looked at his chart and s h e . This is imporrant-stiff feet and posture and the lack of awareness that putsaid, "You'll have to strengthen those calves contribute stiffness o every other it there did& go away. The client will goabdominals; you've got a muscle imbalance joint in the body.And we can interferewith home and torque or overload or suddenlycausingall that pain." To prove her point, other rigidities in our walk bywalking and . strain the back, and the pain may return inshe casually poked at his abdomen-and running backwards. Coordination exercises fa force, and unless you've educated themthen looked shocked. The patient was a arevery helpfd. We can explore the full about the process, they may think the ses-young rugby player with magnificent range of motion of our joints, with move- sion was a failure. You need to loosen themabdominals. He was indeed hyperlordotic, ments that take us through many planes up and get them doing the movement exer-but those strong abdominals weren't cor- (we tend to live in the sagittal, or cises that teach the brain how to isolate,recting it. forwardlbackward, plane). Massage is essen- how to move naturally. There's a long cran-

Why not? Schneider feels that the prob- tial, since it breaks adhesions and creates sition period with ups and downs as theIem in unbalanced movement patterns lies new sensory input to the brain, sending it new adaptations start, and then eventuallywith the nervous system predominantly the message that muscles can be soft and they're complete and the spasm is gone."and the muscles only secondarily. Thus, mobile. And it is essential for clearing up Donegan was already on a one-hourstrengthening the underused muscles muscle spasms. Rolling on the floor or the daily exercise regimen of exercycie work-alone or in conjunction with spinal flex- ground is especially helpful, recruiting side outs, standing lateral and forward bends,ion or extension exercises will not correct muscles that are usually ignored knee bends, and stretches for the groin,the problem. "The brain ignores muscles We've used thegeneral terms "sti~ess," hamstrings, and calvesesL'the standard onesin areas it regards a s unsupported," he "fluidity)))and "immobility" purposely for back pain, on printed sheets that youexplains. "'Support' is good mobility in when talking about evaluating movement; get &om the physical therapist and the chi-the muscles, not brute strength; Mark, for these are fiirly easy distinctions to make, ropractor," Donegan recalls. "They wereexample, i s very strong but stiff in the visually and through touch. Later, the eval- teaching me movements, trying to figurethoracic back, and his brain registers this uator can note muscle spasms or limited out bow to get my legs going again, and itas nonsupport and tends to ignore the range of motion at the joint. Schneider wasn't helping. Meir taught me how tomuscles above it." Schneider's view is at found limited joint mobility in Donegan's move. He pointed out places I was ho' "odds with that of chiropractors and physi- lumbar spine and habitual muscle spasm in myself;I had an immediateknowledgecal therapists, who routinely make use of his psoas, pectorals, serratus anterior, inter- the movements he gave me would relelumbar belts, believing they support the costals, scalenes and sternocleidomastoids. that area and that release there was tht ,.+lower back by immobilizing it. "More natural ways of moving-muscles Every exercise improved a symptom.""Hyperflexibility is also seen by the brain doing only their own work, not adding The regimen that Schneider gaveas nonsupport-if your client is patholog- unnecessary effort, what we call isolation- Donegan is described below because it isically loose-jointed, congenitally or &om can't MIy take hold until h a b i d muscle helpll with his att tern of stiffness andbad stretching programs, there's compen- spasm is gone. And it goes away slowly, muscle tension, and aboveall, because it issatory muscle tightness." very slowly, over time. You can clear it up helping him develop kinesthetic awareness,

We need to interfere with the neural in the session-with Self-Healing so that he can sense for himself the move-habit of overusing some muscle groups, as Neurological Massage (a light-pressure, ments that his body needs. No one pro-if they are the only muscles it is natural to very vigorous vibrating touch that is a cross gram is universally helpkl; this one should


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be looked at in the light of the principleswe have discussed.Exercises to reprogram forsoft, fluidmovement

The exercises need to be repeated manytimes; the effea on the nervous system isslow and cumulative.All rotations shouldbe done in both directions.

Seated: Fist, rotate the navel in thetransverse (horizontal) plane, in one direc-tion and then the other; then, starting atthe base of the spine, do a vertebra-by-ver-tebra version of these horizontal rotations,moving the axis of rotation up one vertebraat a time. Still in the chair, rotate the headin both directions.

Spinal flexion and extension can be per-formed standing or sitting. On his own,the clientwill find it easier to do spinalextension exercises in the prone position,raising the upper and lower body separately,then simultaneously, actively (bow or locustmovements) or passively (extending thearms to passively extend the upper spine).Check whether the client isa MacKenzie orWilliams type, and let flexion or extensionprodominate accordingly. (Some peoplewith back problems have normal lordosis;give them equal amounts.) To create kines-thetic awareness, perform theseexercisesvery slowly, fd ing each vertebra.

On the floor: Roll from side to side onthe floor. On hands and knees, divide theback into four segments-lower, waist,

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On h an d an d knees,Donegan raises and l o w m

and lower each segment repeatedly. In

followed by massage in the prone posi-tion, with the knees drawn under theabdomen.) In the supine position, kneesbent and apait, soles touching, groin asopen as possible, bring each knee alrer-nately all the way over to the opposite sideand back again. Hold the breath on theinhale, raise and lower the abdomen 10times, then hold the breath on the exhaleand do the same thing. Next, as you inhale,picture yourseiffillingwith air like apitcher filling with water all the way up tothe top of the chest; picture the air pouringout Mly as you exhale. Make circles withthe fingers, then the wrist, then the fore--arm, tapping on muscles (especially flexors)proximal to the joint with the other hand,to dampen the involvement of unnecessar-ily recruited muscles. Rotate the shoulder.

Standing, kick each leg sideways. Standon a stair or step, let one leg hang downand rotate it in both directions. W1th yourback to the stairs, lift each leg alternately tothe lowest stair. Then walk backward.

Massage therapist Ferrell was advised tofollow up with deep tissue massage to theentire thoracic area and gentle effleurage,tapotement atld vibration to the lower andupper back

Donegan practiced the exercises for twohours a day; as his endurance increased, hewent up to four hours a day and then six.He enrolled in the School for Self-Healing-and is now an advanced student. Recently

I he had surgery to remove the bolts and' braces from his back. When he recoveredI consciousness afier the surgery, he began1 gemng massage and doing movement exer-cises-head and neck rotations-in the

hospital bed. "The massage was a stronger

painkiller than hree pain pills, and lastedlonger," he said. Two and a half weeks later,the swelling had disappeared an d he couldride his beloved bike again.

"Now I feel that I've created enoughlooseness and awareness in my body so Iknow the next step-how to respect mypain, not move it, stay in my good range-then move it, move through it, soften it,move more fluidly" he said. "The worstthing about the pain was haw it isofatedme socially. These days, I can visit myfriends, go there on my bike, hang out,without having to get up and leave becausethe pain is too bad. I have a full social lifeand I'm building a massage and movementbusiness in Ukiah. I feel like in two yearsI'll have l l l y recovered.".a.

Meir Schneider, Ph.D ., L.M.T, an inter-nationany known therapist and educator, isthe creator ofth e Meir Schneider Self-Healing Meth od the author of two books,Self-HealingM y Lie and Vision andTheHandbook of Self-Healing, and thefundPr/&ectar of the Center an d Scho olfirSeIf-Healing in San Fiamkco .A a teenagqhe overcmne blindness c a w d congenitalcatamcts an d other serious viswn problems a ndto& has an unrestricted driver2 license. For

fi sh er infirmution, cad(415) 65-9574Carol Gadup is a n advanced student of

SeEf-Healing, Registrar of the Schoolfr StFHealing, stu fw rit er of the Self-HealingResearch Foundztion, and the autho r ofnumerous magawawnerti ck . She studiedphysical therapy at the M a y Clinic an d isnow a master2 degree candidate in r es ea ~ hpsychology a t San Francisco State University

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1Moving Out of Back Problems